Saginaw Employment Application

INSTRUCTIONS: Completion of this form is voluntary. Failure on your part to furnish all or part of the information requested may result in denial of your application. Employment is subject to applicants' satisfying the City's requirements as to morals, character, reference and physical examination. This application must be renewed after three months and becomes the property of the City of Saginaw. The City of Saginaw does not discriminate on the basis of race, color, national origin,sex, religion, age, or disabled status in employment or the provision of services.

First Name*

Middle Name

Last Name*

Today's Date

Date

Email Address *

example@example.com

Position Applied For:*

Address*

Address

Street Address Line 2

CityState

Zip Code

Phone Number*

Please enter a valid phone number.

Cell Phone*

Driver’s License Number*

Driver's License Type*

Class C or CDL

Driver's License State Issued*

Drivers License Expiration*

Date

If you are under 18 years of age, can you provide proof of your eligibility to work?*

YesNo

Have you ever filed an application with us before?*

YesNo

Have you ever been employed with us before?*

YesNo

If Yes, give date:*

Are you currently employed?*

YesNo

May we contact your present employer?*

YesNo

Are you prevented from lawfully becoming employed in this country because ofVisa or Immigration Status?*

YesNo

Proof of citizenship or immigration status will be required upon employment.

Are you available to work*

Full TimePart TimeShift WorkTemporary

Are you currently on “lay‐off” status and subject to recall?*

YesNo

Are you currently a member of a military unit?*

YesNo

Have you been convicted of a felony within the last 7 years?*

YesNo

Conviction will not necessarily disqualify an applicant from employment.

If Yes, please explain*

High School Name

High School City/State

Undergraduate College/University Name

Undergraduate College City/State

Undergraduate College/University Degree

Other Education

Other Education City/State

Other Education Degree

Summarize special job‐related skills and qualifications acquired from employment or other experience.

Describe any job-related training received in the United State Military.

Specialized Skills (select all that apply)

Production/Mobile Machinery (list):

Other (list):

State any additional information you feel may be helpful to us in considering your application:

Employer Name

Employer Address

Job Title

Start Date

Date

End Date

Date

Starting Salary

Final Salary

Employer Phone Number

Supervisor

Work Performed

Reason for Leaving

Employer Name

Employer Address

Job Title

Start Date

Date

End Date

Date

Starting Salary

Final Salary

Employer Phone Number

Supervisor

Work Performed

Reason for Leaving

Employer Name

Employer Address

Job Title

Start Date

Date

End Date

Date

Starting Salary

Final Salary

Employer Phone Number

Supervisor

Work Performed

Reason for Leaving

Employer Name

Employer Address

Job Title

Start Date

Date

End Date

Date

Starting Salary

Final Salary

Employer Phone Number

Supervisor

Work Performed

Reason for Leaving

List professional, trade, business or civic activities and offices held.

You may exclude membership which would reveal gender, race, religion, national origin, age, ancestry, disability or other protected status.

Name

Phone Number

Address

Name

Phone Number

Address

Name

Phone Number

Address

Are you related to any member of the City Council or any current City of Saginaw employee?

YesNo

If “Yes.” Name of Relative:

Relationship

Department they work in

Resume

Cover Letter

Other relevant documents

Do not upload any personal sensitive information.

Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING.

Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied? A description of the activities involved in such a job or occupation is attached.

YesNo

EMPLOYMENT AT‐WILL STATEMENT

ln consideration of my employment, I agree to conform to the rules and regulations of the City of Saginaw, and my employment and compensation can be terminated with or without cause, and with without notice, at any time, at the option of the City or myself.

APPLICANT'S CERTIFICATION

I have reviewed the principle job duties and the minimum qualifications for the position for which I have applied. I am aware that this application will be subject to public disclosure unless an exception under the Texas Open Records Act is applicable.

The information on this application is accurate to the best of my knowledge and is subject to verification by the City of Saginaw if so requested. I understand that the information provided by me herein may be used for the purpose of investigating my eligibility and my previous employers may be contacted. I agree that the City of Saginaw will not be liable for any damage which may result from the release of such information, and that any misrepresentation or deliberate omission in my application may be justification for refusal of, or termination of, employment with the City of Saginaw.

My signature below indicates that I have read and fully understand the foregoing statements

Signature

Date

EMPLOYMENT APPLICATION

Education

Additional Information

Check Skills / Equipment Operated

Employment Experience

Employer #1

Employer #2

Employer #1

Employer #4

Professional References (No Relatives)

Reference #1

Reference #2

Reference #3

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